You will have R-CHOP in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give you your treatment. During treatment, you will usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.

Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.

You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.

Your nurse will give you paracetamol tablets before you start your treatment. They will then give you anti-sickness (anti-emetic) drugs and an antihistamine as an injection into a vein or as tablets.

Your treatment will be given through one of the following:

a short, thin tube (cannula) that the nurse puts into a vein in your arm or hand

a fine tube that goes under the skin of your chest and into a vein close by (central line)

a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).

You will also be given prednisolone tablets. You usually take the first dose of prednisolone before the rituximab. You'll then be given a course of prednisolone tablets to take at home, usually for five days in total.

Some people have a reaction to rituximab. The paracetamol, antihistamine and prednisolone help reduce the chance of this happening.

The nurse will give you rituximab as a drip into your vein. They will usually run the drip through a pump, which will give you the treatment over a set time. Your nurse will then give you doxorubicin (a red fluid) and cyclophosphamide as injections directly into your vein. You will also have a drip (infusion) to flush the treatment through. You’ll be given vincristine as an infusion (drip) over 5–10 minutes, with fluids given before and after it.

Your course of R-CHOP

You will have treatment as a course of several sessions (or cycles) over a few months. Each cycle of R-CHOP takes 21 days (three weeks).

On the first day of each cycle, you will have rituximab, doxorubicin, vincristine and cyclophosphamide. You will also start taking a five-day course of prednisolone tablets.

At the end of the 21 days, you will start your second cycle of R-CHOP. This is exactly the same as the first cycle. You will have up to eight cycles over 3–4 months. Your doctor or nurse will tell you the number of cycles you are likely to have.

When R-CHOP is being given

Some people might have side effects while they are having this treatment.

Allergic reaction

Rituximab may cause an allergic reaction while it’s being given. This is more common with the first treatment, so you will have it slowly over a few hours. The nurse will give you drugs to help prevent or reduce this. They will check you for signs of a reaction. If you have one, they will treat it quickly.

Signs of a reaction can include:

flu-like symptoms (headaches, a high temperature or chills)

feeling sick

a rash

feeling itchy

breathlessness

having pain in your back, tummy or chest

feeling unwell.

Tell your nurse straight away if you have any of these symptoms.

Rarely, a reaction can happen a few hours after treatment. If you develop any of these symptoms or feel unwell after you get home, contact the hospital straight away for advice.

Facial flushing

You may suddenly feel warm and your face may get red while the treatment is being given. This should only last a few minutes.

Low blood pressure

Some people's blood pressure falls while they are having rituximab. If you usually take medicine to lower your blood pressure, your doctor may ask you not to take it for 12 hours before having rituximab. The nurse will check your blood pressure regularly.

A drug leaks outside the vein

If this happens when you’re having chemotherapy, it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common, but if it happens it’s important that it’s dealt with quickly.

If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.

Going home

Before you go home, the nurse or pharmacist will give you anti-sickness drugs to take. Take these tablets and the prednisolone exactly as explained.

We explain the most common side effects of R-CHOP here. But we don’t include all the rare ones that are unlikely to affect you.

You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have.

Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.

Serious and life-threatening side effects

Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.

More information about these drugs

We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).

Risk of infection

R-CHOP can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.

Contact the hospital straight away on the contact number you’ve been given if:

your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team

you suddenly feel unwell, even with a normal temperature

you have symptoms of an infection – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.

The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If the number of white blood cells is still low, your doctor may delay your treatment for a short time.

Bruising and bleeding

R-CHOP can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.

Anaemia (low number of red blood cells)

R-CHOP can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).

Feeling sick

This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.

If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.

Some anti-sickness drugs can make you constipated. Tell your doctor or nurse if this is a problem.

Tiredness

Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.

Hair loss

You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.

Sore mouth

Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth or dentures every morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.

Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.

Constipation

Vincristine may make you constipated and cause tummy pain. Drinking at least two litres (three and a half pints) of fluids every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and do some regular, gentle exercise.

If you haven’t had a bowel motion for two days, contact the hospital for advice. Your doctor can prescribe laxatives to help you. Always contact the hospital straight away if you are constipated and have tummy pain or are being sick.

Bladder irritation

Cyclophosphamide may irritate your bladder and cause discomfort when you pass urine. Drink at least two litres (three and a half pints) of fluids during the 24 hours following chemotherapy. It is also important to empty your bladder regularly and to try to pass urine as soon as you feel the need to go.

Contact the hospital straight away if you feel any discomfort or stinging when you pass urine, or if you notice any blood in it.

Discoloured urine

Your urine may be a pink-red colour for up to 48 hours after you’ve had your treatment. This is due to the colour of doxorubicin.

Numbness or tingling in the hands or feet

These symptoms are caused by the effect of vincristine on nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but in some people they may never go away. Talk to your doctor if you are worried about this.

Raised blood sugar levels

Steroids can raise your blood sugar levels. Your nurse will check your blood regularly for this. They may also test your urine for sugar. Symptoms of raised blood sugar include feeling thirsty, needing to pass urine more often and feeling tired. Tell your doctor or nurse if you have these symptoms.

If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this. You may need to check your blood sugars more often or adjust your insulin or tablet dose.

Tummy pain and/or indigestion

Steroids can irritate the stomach lining. Let your nurse or doctor know if you have pain in your tummy or indigestion. They can prescribe drugs to help reduce stomach irritation. Take your tablets with food to help protect your stomach.

Increased appetite

Steroids can make you feel much hungrier than usual and you may gain weight. Your appetite will go back to normal when you stop taking them. If you’re worried about gaining weight, talk to your doctor or nurse.

Build-up of fluid

You may put on weight or your ankles and legs may swell because of fluid building up. This is caused by prednisolone and is more common if you are taking it for a long time. Tell your doctor or nurse if fluid builds up. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion. The swelling gets better after your treatment ends.

Skin changes

R-CHOP may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat.

Your skin may darken. It will return to its normal colour after you finish treatment. If you’ve had radiotherapy either recently or in the past, the area that was treated may become red or sore.

Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

Nail changes

Your nails may become brittle and break easily. They may get darker or discoloured, or you may get lines or ridges on them. These changes grow out after treatment finishes. Wearing gloves when washing dishes or using detergents will help protect your nails during treatment.

It is fine to wear nail polish, but you should avoid wearing false nails during treatment.

Raised levels of uric acid in the blood

R-CHOP may cause the cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. Too much uric acid can cause swelling and pain in the joints, which is called gout.

Your doctor may give you tablets called allopurinol (Zyloric ®) to help prevent this. Drinking at least two litres (three and a half pints) of fluid a day will also help. You will have regular blood tests to check the uric acid levels.

Changes in the way the liver works

R-CHOP may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.

Jaw pain

Vincristine may cause pain in your jaw. Tell your nurse or doctor if you notice this.

Eye problems

Your eyes may feel sore or dry. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops. Vincristine may rarely affect your vision. Always tell your doctor or nurse if you have eye pain or notice any change in your vision.

Changes in the way the heart works

Some of the drugs can affect the way the heart works. You may have tests to see how well your heart is working before, during and sometimes after treatment.

If you have pain or tightness in your chest, feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions, but it’s important to get them checked by a doctor.

Effects on the lungs

R-CHOP can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, a fever or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.

Mood and behaviour changes

Steroids can affect your mood. You may feel anxious or restless, have mood swings or problems sleeping. Taking your steroids in the morning may help you sleep better.

Effects on the nervous system

R-CHOP can affect the nervous system. You may feel dizzy or unsteady. Tell your doctor or nurse straight away if you notice any of these symptoms. They may make some changes to your treatment if they become a problem for you. It’s important not to drive or operate machinery if you notice these effects. Rarely, this treatment can cause seizures (fits).

It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.

Blood clot risk

Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as:

pain, redness and swelling in a leg

breathlessness

chest pain.

Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.

Other medicines

Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.

Fertility

R-CHOP may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.

Contraception

Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.

Sex

If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in your semen or vaginal fluid.

Changes to your periods

R-CHOP can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women this is temporary, but for others it is permanent and they start the menopause.

Breastfeeding

Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.

Medical and dental treatment

If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.

Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.

This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.

This information was reviewed by a medical professional.

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